Adenoma Type, Number Should Guide Follow-Up Interval After Colonoscopy: Guidelines

By Will Boggs MD

March 02, 2020

NEW YORK (Reuters Health) - Follow-up intervals after colonoscopy and polypectomy can be as long as 10 years with small, low-risk adenomas or hyperplastic polyps, or as short as one year for multiple adenomas, according to updated recommendations from the U.S. Multi-Society Task Force on colorectal cancer.

Dr. Samir Gupta of Veterans Affairs San Diego Healthcare System and the University of California, San Diego, in La Jolla, and colleagues reviewed the literature in order to update the 2012 advice for follow-up after colonoscopy with or without polypectomy.

The complete recommendations, along with the evidence supporting them, appear in Gastroenterology. They all rely on having a high-quality colonoscopy, which should be complete to the cecum, have adequate bowel preparation to detect polyps larger than 5 mm, have adequate colonoscopist adenoma detection rates and include complete polyp resection.

Several changes from the 2012 recommendations are noteworthy. First, the polyp-surveillance recommendations have been strengthened by new evidence based on the risk of cancer outcomes, rather than based merely on the risk of advanced adenoma during surveillance.

Second, seven- to 10-year follow-up, rather than five-10 years, is now recommended after the removal of one or two tubular adenomas smaller than 10 mm in size.

Third, there are now more detailed advice for follow-up after removal of serrated polyps, with different recommendations according to size and number and the presence of dysplasia.

Fourth, one-year follow-up is now recommended after removal of more than 10 adenomas instead of the less-than-three-year follow-up previously recommended.

Finally, colonoscopists have the option to recommend three to five years, instead of three years, for follow-up after removal of three to four adenomas smaller than 10 mm.

"Evidence to support best practices for surveillance colonoscopy has strengthened and has helped to support close follow-up for some groups, as well as less intense follow-up for others," the task force concludes. "More work is needed to fully understand which patient populations are most likely to benefit from surveillance and the ideal surveillance interventions to apply for optimizing colorectal cancer prevention and early detection."

Dr. Michael Hoffmeister of the German Cancer Research Center, in Heidelberg, who studies colorectal cancer, told Reuters Health by email, "The empirical evidence or evidence quality is still low for some of the recommendations, especially for those referring to serrated polyps. This is not a weakness of the recommendations, because they are based on current evidence. It just highlights where more research is needed. The increasing complexity of follow-up intervals might be considered a challenge by endoscopists."

"The change of the recommendations after detection of 1-2 adenomas <1 cm to have follow-up colonoscopy 7-10 years later instead of 5-10 years later" deserves emphasis, said Dr. Hoffmeister, who was not involved in the new guidelines. "New evidence suggests that the risk for advanced adenomas and cancer is low and only a little higher than among patients with a normal (negative) colonoscopy, for whom a 10-year interval applies."

Dr. Gupta did not respond to a request for comments.

SOURCE: Gastroenterology, online February 7, 2020.